Provider Demographics
NPI:1184875007
Name:LOUIS STERN MD PA
Entity type:Organization
Organization Name:LOUIS STERN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-843-8994
Mailing Address - Street 1:117 WEST UNDERWOOD STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-894-8994
Mailing Address - Fax:407-843-8490
Practice Address - Street 1:117 W UNDERWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1137
Practice Address - Country:US
Practice Address - Phone:407-894-8994
Practice Address - Fax:407-843-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035670100Medicaid
FL266768679OtherTRICARE
FL30842OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLP00069500OtherMEDICARE RAILROAD
FL266768679OtherTRICARE